CARE HOMES FOR OLDER PEOPLE
Balcombe Place Haywards Heath Road Balcombe West Sussex RH17 6QJ Lead Inspector
Miss Helen Tomlinson Unannounced Inspection 9th November 2005 12.30p X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Balcombe Place Address Haywards Heath Road Balcombe West Sussex RH17 6QJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01444 811066 01444 811139 Balcombe Care Homes Ltd Mrs. Jill De Le Vingne Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd June 2005 Brief Description of the Service: Balcombe place is registered to provide accommodation and nursing care for up to forty older people. The property is a large, tastefully adapted country house which stands in twelve acres of its own grounds. It is situated down a private drive south of the village of Balcombe. Residents are accomodated in twenty four single and eight double rooms situated on the three floors of the home. A passenger lift is available to all floors. Communal areas consist of a large entrance hall with seating, a library, music room and dining room. There is outdoor seating in the extensive gardens and patio areas. Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 12.30pm and left at 6pm. The registered manager was present throughout the inspection. During the course of the inspection thirteen residents, four visitors and five members of staff were spoken with. A tour of the premises took place. Several resident’s files were examined to look at specific records and other documentation was read. What the service does well:
Residents spoke highly of the staff working at the home. Comments made included “very helpful”, “polite” and “all of them are so kind”. They talked about some staff “going out of their way to do the little things which were so important.” Staff were seen to discuss with residents things they would like bringing in for them, which the visiting shop did not have. Staff would shop for residents, in their own time, and deliver these goods. Residents could place orders at the visiting shop for specific items and these would normally be available the following week. Most residents spoken with were very happy with their bedrooms. These range greatly in size and shape since the building is a very old adaptation. Many are large rooms with space enough for a sleeping and sitting area. The en-suite bathrooms are large enough for a bath, in most rooms, or a shower. There are some smaller rooms in the home, none of which are under ten square metres. Residents could bring in their own furniture and possessions, in agreement with the manager, and make their bedroom personal. The furnishings, fixtures and fittings were of a high standard and all bedrooms were tastefully decorated and well maintained. The manager explained that as bedrooms became vacant they were being decorated and upgraded, particularly the en-suite bathrooms, some of which needed handrails and other adaptations fitting. There is a large amount of communal space offering residents a choice of sitting with other residents, or alone in pleasant surroundings. The main lounge provides comfortable seating in a very domestic setting. The music room, whilst being more formal, again provides a variety of seating and lovely views of the garden and open countryside. Many residents chose to sit in the main hall, where they can see the comings and goings of the staff and visitors. Supervision is provided by the receptionist, for most of the day, in this area. Residents spoke very highly of the food served in the home. They discussed various dishes on the menu including crab starters to duck main course and a large choice of desserts. They said there was a good variety of food served, which was always well cooked and beautifully presented. Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 6 Residents said they were happy and confident to approach the manager, or any other member of staff if they had a concern about anything in the home. They said if they had discussed anything it had been dealt with swiftly. Staff treated the residents with dignity and respect, whilst being friendly and chatting about personal things which were obviously important to the residents. The social and past lives of the residents were understood by the staff and seen to be included as part of their care. The interactions with visitors and support of two residents to keep their dogs in the home were examples of this recognition of the importance of all of their lives, not just their physical needs. What has improved since the last inspection? What they could do better:
During the tour of the premises not all cupboards containing cleaning and hazardous materials were locked. These should be secured, for resident’s safety at all times. The necessary information for action to be taken, in case of spillage of these products was not present in these rooms. This information should be available wherever these products are stored. A separate hand washbasin must be provided in the laundry to help staff prevent the spread of infection. Training in infection control should be provided for all staff. Fire doors must not be wedged open. The procedure for the reporting of any allegation of abuse in the home must be in line with current guidance. Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. Standard 3 was met at the last inspection. Standard 6 does not apply to Balcombe Place since intermediate care is not provided. EVIDENCE: Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 All residents had an up to date care plan in place. The health care needs of the residents were met. Medication was stored, administered and recorded safely. EVIDENCE: Three residents files were examined in detail. At the last inspection several of the plans of care and health assessments were not up to date and had not been reviewed regularly. At this inspection the care plans had been reviewed, the health assessments were up to date and the information in both documents was consistent. The records for wound care had been changed since the last inspection and now contained detailed information regarding the wound site and dressings applied. Risk assessments for falls and other individual risks, such as the residents refusing to use footplates on a wheelchair, were present and signed by the residents. One of the registered nurses had completed a project with the National Osteoporosis Society, which included the prevention of falls. It was discussed that some of the records and other learnings could be used to good effect in the home. One of the registered nurses had completed training to become a moving and handling coordinator. They were now responsible for the training of staff in the home and assessing the residents for the use of equipment.
Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 11 There was evidence that other health professionals were consulted when necessary and the manager said there was a good working relationship with the local G.P.s, pharmacists and specialist nurses. At the last inspection a requirement was made regarding some practices in the home of medication administration and recording which did not meet with the guidance of the Nursing and Midwifery Council. At this inspection these issues had been resolved and the manager confirmed that the current guidance was adhered to. Those residents who chose to administer their own medication were assisted and supported to do so. A risk assessment for the safety of this practice had been devised and was in place for all residents who chose to do this. It was discussed with the manager that signage to warn of the presence of oxygen should be fluorescent. Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. All of these standards were assessed and met at the last inspection. Standard 15 regarding the food in the home was exceeded and residents reported at this inspection that the food was “superb” and “like a five star hotel.” EVIDENCE: Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents were confident that any concerns raised by them would be dealt with appropriately. Residents were protected from abuse. The procedure for dealing with any allegation of abuse was not in line with current guidance. EVIDENCE: Six complaints had been made in the home, in the past twelve months. These had been fully recorded, with the investigations and actions taken documented. All these complaints had been resolved to the satisfaction of the complainant. Residents spoken with said they would approach any of the staff or the manager if they were concerned about any aspect of life in the home. They said if they had done this all issues had been dealt with quickly and to their satisfaction. They said all staff were very approachable and helpful if there was anything troubling them. The complaints procedure was on display in various parts of the home. At the last inspection the procedure for reporting any allegation of abuse did not meet with current guidance, and an allegation of abuse had not been reported to the correct authorities. This had been dealt with using the care home’s disciplinary procedures. It was required that the procedure be changed and all persons who may be in charge of the home were aware of the correct procedure to take. At the time of this inspection some amendments had been made to the procedure, but this remained incorrect. It was not clear that other agencies must be informed and may lead the investigation into any allegations of abuse made. This requirement remains unmet. Staff spoken with were aware of their responsibility to protect the vulnerable adults in their care. Some had received training in this aspect of their work.
Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24 and 26. Residents live in a well-maintained environment. The fire safety in the home had improved since the last inspection, but a requirement regarding the wedging open of fire doors remains in place. Residents have access to a large amount of comfortable indoor and outdoor communal space. The resident’s bedrooms vary in size, but all provide adequate space and many offer a very spacious, comfortable and pleasant room. Residents have their own personal possessions in order to feel more at home. There are adequate number of lavatories and bathrooms in the home. Most bedrooms have spacious en-suite facilities. The home was clean, pleasant and tidy. EVIDENCE: Balcombe Place is an old building which has been converted. It is an imposing stately home, in extensive grounds, with some landscaped areas. The interior and exterior of the building were well maintained, with an ongoing programme of repair and redecoration in place. The manager explained that as the bedrooms became vacant they were decorated and the en-suite facilities
Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 15 updated. Where this had been completed there was a marked improvement, with more modern facilities and additional handrails and other aids provided. Since the last inspection one staircase had new carpet laid, with treads applied. At the last inspection the requirements made by the fire service, in the past twelve months, had not been completed. This work was ongoing and at this inspection the majority of the works were done. The fire officer had visited the home the week prior to this inspection and was satisfied with the progress made. A further visit would be made by them on completion of the works. Additional to the fire service requirements it was required, at the last inspection, that no fire doors were wedged open. Devices which meet the guidance of the fire authority should be fitted. At this inspection doors onto corridors, from the lifts, had these fitted. Some bedroom doors were wedged open and this should not continue. The requirement remains in place. Residents spoken with about the environment of the home said they were very happy with it. They said it was always clean, they had homely communal space to use and in good weather the grounds were accessible and peaceful. The indoor communal space comprises of a large main hall with three separate seating areas, a large lounge with comfortable seating, an area to play board games and a library, a music room with grand piano and various seating and a large, wood panelled, dining room. The entrance hall of the home also has comfortable seating available. Residents could chose to sit in any of the communal areas and many did so at various parts of the day. Activities took place in the music room and residents said some visitors liked to play the piano. In the past residents have done so, but currently none do. The outdoor space is vast with some landscaped gardens and patio areas. Residents were assisted to sit outside if they wished. Most residents said they liked their bedrooms, which were mostly spacious, giving room for a bed area and separate seating area, with writing desk and comfortable chairs. The rooms were not uniform in shape, size or decoration, but were in character with the stately building and homely. Residents chose to spend their time in their bedrooms or the communal areas, as they wished. At the time of this inspection four bedrooms were shared by two people, although more had adequate space to accommodate two residents. The en-suite faculties varied in size, with most having a bath. These were being updated when the bedrooms were vacant. Those which had been done were improved with additional handrails and adaptations being fitted. Four bedrooms do not have en-suite facilities. Toilets and bathrooms were available for residents who were accommodated in these rooms. A toilet was available close to the communal areas. Baths had adaptations to assist residents who could not get into and out of the bath. Other equipment necessary to meet the needs of the residents was provided. Hoists, belts and slide sheets for the moving and handling of residents were present. The manager said all residents requiring nursing care had adjustable height beds in place. The manager said she carried out an assessment of all residents before they are accommodated in the home. This includes an assessment of whether the equipment in the home Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 16 can meet their needs and if the en-suite facilities are suitable and safe for their use. Residents commented on the cleanliness of the home saying it was always clean and tidy. They said their bedrooms were kept clean and cleaning staff were helpful and polite. Staff spoken with knew about their role in the control of infection in the home. They had not received specific training for this and it was recommended that this take place. All bedrooms and bathrooms had appropriate hand washing facilities. There was no designated hand washbasin in the laundry. This should be provided. Soiled linen was placed into special bags which go into the washing machine with it. Staff wore protective clothing when assisting residents with personal care and when handling food. Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 Staff were recruited in a way which safeguarded the residents. Residents benefited from staff who were trained to meet their needs. EVIDENCE: At the last inspection the staff files seen did not contain the necessary information and checks, which should have been obtained before the person started work. One staff member had been recruited since the last inspection. Their file contained all the information necessary and showed this person had been recruited in a way which ensured all checks were done to safeguard the residents. The registered manager said the recruitment process for the home had changed since the last inspection and she was fully involved from the start. Staff received training in various aspects of their work. New staff had induction training which included fire safety, moving and handling and other training which would be required for the work. Some of this training should be followed up in more depth at a later stage, including infection control and health and safety. Specific nursing issues were discussed with staff when a new resident was admitted or at any other time it was necessary. The manager said she updated herself by attending training courses, reading the nursing press and using the internet. One of the registered nurses had completed training as a moving and handling co-ordinator in order to train all staff at the home. Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36 and 38 The registered manager has the experience and knowledge to run the home. The home is run in the best interests of the residents. Staff receive support and supervision from the manager. The health and safety of the residents is protected. EVIDENCE: The registered manager has run the home for ten years. She is a Registered General Nurse with many years experience in the care of older people. She keeps herself updated on nursing issues by reading the nursing press, using the internet and attending training courses. She receives supervision from the operations manager of the organisation and attends meetings with the managers of other homes in the group. The registered manager and other staff were aware of the importance of including the residents in the decision-making processes in the home. They were seen to discuss the daily life in the home with the residents on an informal basis. The registered manager discussed the quality assurance
Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 19 measures in the home. Questionnaires are sent out to residents and other stakeholders seeking their views on various aspects. There is usually a large number of the questionnaires returned. The registered manager then uses these as part of the presentation she makes to the higher management of the home, regarding the next years plans. Staff meetings take place. Staff are required to review the policies and procedures within the home, recording any issues arising and presenting actions to improve the service. Some audits of the service take place by the registered manager. The manager said she supervises the staff regarding their daily work and training needs. She has one to one supervision at least three monthly, but wishes to increase this to every six weeks. This supervision is recorded and any ongoing issues are followed up. All staff have an annual appraisal. Staff spoken to said they could approach the manager or any other staff at any time. They liked the supervision sessions and found them useful. Staff spoken with were aware of their responsibility for the health and safety of the residents. They had not received specific training on this issue and it is recommended this take place. During the tour of the building three issues of health and safety were noted which have been highlighted in the report. These were the hazardous cleaning substances not securely stored, the data sheets for these not being present and some fire doors being wedged open. Requirements have been made regarding these issues. The accident book was seen. Accidents and any actions taken were recorded. The registered manager said that all equipment was serviced and tested in accordance with the manufacturers guidance. All electrical equipment was PAT tested. Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 3 3 3 3 x 2 STAFFING Standard No Score 27 x 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x 3 x 2 Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 13(6) Requirement The procedures to be followed, should an allegation of abuse be made must be in line with current guidance and be a multidisciplinary approach. This requirement remains unmet since the inspection of 23/6/05. The timescale given of 31/07/05 has expired Fire doors must not be wedged open. This requirement remains unmet since the inspection of 23/6/05. The timescale given of 31/07/05 has expired A separate hand washbasin must be provided in the laundry. Staff must receive adequate training in the control of infection and health and safety. All cleaning fluids or other hazardous preparations should not be accessible to residents. The data sheets for these products should be available where they are stored. Timescale for action 31/07/05 2 OP19 23(4)(c)(i ) 31/07/05 3 4 5 OP26 OP30 OP38 13(3) 18(1)(c )(i) 13(4)(a) 31/01/06 28/02/06 31/12/05 Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP26 Good Practice Recommendations Oxygen warning signs should be fluorescent. Laundry staff should wear protective clothing when dealing with soiled linen. Balcombe Place DS0000024111.V263618.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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